HC3, in partnership with Edelman, hosted a virtual conversation on January 17 regarding the interconnected nature of trust in health care and its indispensable role in achieving greater equity in outcomes. This conversation explored the difficulties and possible advantages that affect adherence to treatment, patient welfare, and overall health results. It also examined ways to increase understanding of how people and organizations can leverage external elements to boost their approaches in enhancing patient experiences and outcomes.
Amira Barger, MBA, CVA, CFRE, Executive Vice President, Head of DEI Advisory, Health Communications, Edelman
Temeika Fairley, PhD, Senior Health Scientist, Division of Cancer Prevention and Control, The Centers for Disease Control and Prevention.
Kristi Mitchell, MPH, Co-founder and Principal, ATLAS CLARITY LLC and Health Equity Outcomes (HEO)
Watch the Webinar:
Event Recap (Responses condensed for clarity and brevity)
Amira Barger (AB): Edelman recently launched our 2024 Annual Trust Barometer with the headline “Innovation in Peril.” The findings from this year's report are profound, particularly against the backdrop of all we're seeing happening and converging in today's world. Think about the global conflicts we've all been watching, experiencing, and learning about. There's a surge in artificial intelligence, 60 or more elections taking place across the globe, and so many other things are happening in the world. This year's trust report by Edelman underscores that innovation plays a vital role in creating and highlighting trust. Many of the respondents to our annual trust survey this year agree that scientists are essential to the acceptance of innovation.
Today's panel is intended to discuss the nature of trust in health care and its role in achieving greater equity in outcomes for patients like you and me. A mass divide was revealed in the 2023 Trust in Health Barometer, which is manifesting in health care. Inequality is creating a tale of two experiences that are shifting the landscape of health. More people are reporting gaps and how well they're taking care of their health. Cost is among the most significant barriers to reaching every individual's health goal, based on those who responded to our survey. Inflation is at the top of societal concerns and negatively impacts people's health. Institutional leaders were also reported as an area of concern and presented an opportunity to address health inequities and dispersion of authority. Investing in employee health and optimizing offerings and benefits around health and the community's needs is also an opportunity. In 2023, the Trust and Health study found that only 1 percent of our respondents defined being healthy as purely physical, so people think about their health more expansively. You can learn more from Edelman’s full Trust Study from 2023, and 2024 is coming soon.
Dr. Tameika Fairley (TF) is a senior health scientist and the acting lead for communications in the CDC’s Division of Cancer Prevention and Control. In her role, she oversees all cancer-related health, communication, and education efforts for the CDC. That includes oversight of the CDC's award-winning public cancer education campaigns like Bring Your Brave, Inside Knowledge, and Screen for Life, each of which focuses on cancers that disproportionately affect people of color. Dr. Fairley also leads the CDC's Early Act program addressing breast cancer in young women. She recently served as the Associate Director for Health Equity and Health Communication in the White House Office of Science and Technology.
Kristi Mitchell (KM) is an MPH and founder of Health Equity Outcomes, as well as the founder and principal of Atlas Clarity, LLC. Kristi has a background in health services research, and she's dedicated over 25 years to transforming health care delivery through innovation, value, and engaging customers. She previously served as a practice director at Avalere Health, where she led the Center for Health Care Transformation for over a decade before founding Health Equity Outcomes.
AB: In the context of health equity today, what key challenges persist, particularly in cancer prevention? How can those challenges be effectively addressed to ensure fair and inclusive health care practices?
TF: Cancer is a disease of time and access. One of the most significant issues is access to equitable, timely, and appropriate care for people who are facing cancer, not just their diagnosis, not just their treatment. But from the beginning to the end of life. It’s a huge issue making sure that people are not only diagnosed in a timely fashion but that they also get their treatment in a timely fashion. This applies to mental health as well. We're also still seeing too much research that says African-American women are not getting the same level of pain treatment as some other women with cancer, so making sure that everyone gets the right care at the right time is probably the biggest issue.
AB: In your work, are you aware of any examples of community-based organizations that have done really well to prioritize helping people address mental health components that lead to some of the impacts on their physical health?
TF: We certainly see programs that are working on the mental health component. That’s everything from providing access to support groups and various support systems and mechanisms to providing actual care through licensed clinical social workers. The challenge is measuring how well you're doing at that. This is a data issue. It’s a hard question to answer because of that.
KM: It’s not about how much data you have; it's about the right data. We're in a position and a place where we can't even accurately and adequately capture data on race, ethnicity, or language, let alone sexual orientation and gender identity. When we don't have confidence in the data, it makes it that much more difficult not only to show impact but also to engage trust among the folks that we're trying to communicate what they should and should not be doing. This is really critical in the context of cancer prevention, screening, prevention, treatment, and so forth.
As the landscape of health equity evolves, how do you define it? What innovative approaches or strategies have you observed or even implemented, particularly through your work at Atlas Clarity, to address disparities in health care outcomes and help ensure that individuals have equitable access to quality health services?
KM: The community can serve as a foundation for tackling health equity. An important part of innovation is not talking to the community but bringing the community to the table to identify solutions that are actionable. One example is the role of community health workers. During the pandemic, the role of these extenders was highlighted as being a good way of bringing information and helping the community see the value in things such as testing, contact tracing, and vaccinations. We’re seeing an expanded use of these community health to serve as educators, navigators, and potentially researchers.
Another example is something we're doing in Indianapolis. We formed a group called the Community Focused Research Organization, which is a board of diverse leaders that represent health plans, Indian Health Service, LGBTQ, United Way, food banks, and more. In this 18-month project, we wanted to highlight the need for education around the value of clinical trials. Everybody talks about diversity in a clinical trial, but are we going to the source where we can actually affect true change and sustain any gains that we may see? Our goal was to demystify participating in trials. Through a series of community meetings, we used trusted messengers to validate the need to have this information. We piloted in about three hurches within Indianapolis. We trained the pastors first and then supported them as they trained their health and wellness ministries to host workshops and town halls amongst their congregations. We saw an enhanced understanding of why clinical trials are important, and then we also saw a meaningful change in attitudes toward actually participating in trials. Now, we're replicating that same model we put in the faith-based community.
AB: Can you tell us about some of the demographics of the communities you worked with and saw changes within?
KM: We are talking about a predominantly African-American population within Baptist churches or other faith-based groups. The notion of participating in trials is often colored by what older generations have said about Tuskegee or Henrietta Lacks. So, we had to level set that by acknowledging what happened and then talking about what it means to have representation in trials moving forward. We had to meet the community where they were in their general knowledge, understanding, and acceptance of health care. Many of these folks said it's about something other than participating in clinical trials. For them, it is more about meeting their social needs or needs to access medications like insulin. Seeing how other needs came up outside the clinical trial piece was compelling. Another piece was that the vast majority of the people in the room said they'd never been asked to participate in a clinical trial. We assumed that we as people don't participate, but sometimes they need to be invited and offered the education.
AB: What role does communication play in building and maintaining trust, knowing that you've done so much in communications with public education campaigns?
TF: At the federal level, we are doing public education campaigns, but we need help knowing what to say to people. We have big ideas about the messages, but we need to know what people know, how they want to hear it, and what communication streams they want it to come from. We do a lot of formative research where we go out into the community and try to identify the trusted voices in a community. Talking about screening and awareness is very different from messages that we start to craft for someone living with a diagnosis. So, there is a need for sensitivity and to think about how we prepare those messages to our audience specifically.
The Bring You Brave campaign is focused almost exclusively on women between 18 and 44, but the audiences are segmented. In addition to targeting messaging by ethnicity, we’re also making sure to be representative of body types. The science shows that that's an issue when you start talking about getting screening, such as cervical cancer screening, because of how people feel like they show up in the clinic. We try to be thoughtful about how to address some of those things.
KM: I'm curious about your experience using technology to create those messages.
TF: We’ve tried to get conversations about cancer into gaming to reach certain age demographics. For example, we’ve been attempting to use Call of Duty.
AB: The intersection of health equity and technology is increasingly important. What is your reaction to how technology is being used today? How can we, from a position of being equitable and considering different community needs, be thoughtful about using technology to advance health access and outcomes?
KM: digital health has the potential to make health care more equitable. As was mentioned, we are seeing recognition that addressing social drivers of health is a part of achieving health equity. Digital platforms like Unite Us have been developed to close the gaps between timely referrals to social services, bridge the gaps between medical and behavioral providers in some cases, and build in culturally appropriate networks. We're beginning to see how technology can address health equity. But I am concerned about how long it will last and what will happen to people who rely on it if it goes away. Trust is lost when something that provides hope is suddenly retracted. I have a concern as we begin to rely on digital apps and technology in this space.
TF: It’s also important with these solutions to consider who the builders are and if they are people who come from these communities or look like those from them. I would go out on a limb and say no. So then there’s a question of how do we change that like that? It’s an important factor to consider because there is often a loss of interest or loss of political will.
AB: What attributes make someone a trusted messenger to the communities you’ve worked alongside to promote greater health equity and engagement in their care with their physicians?
KM: The number one attribute I see in this trusted messenger space is that they look like us. The representation. The other piece is the message itself. You could have someone that looks like me, but the message can't be adopted because they don't understand what you're saying. The message is equally important as the messenger. The third piece is where or how it’s being delivered. People may not be receptive to hearing about cancer screening when standing at the bus stop trying to go to work.
TF: I have found that when I'm talking to young women in their twenties or so, there are certain messengers they want to hear from, and we may have biases about who those messengers are. If their favorite Instagram influencer is the person who can best deliver this message to them at this time, then we have to consider that.
Healthcare providers can be another trusted messenger, but a lot of times, there are trust issues. It can be helpful to encourage people to build a relationship with their health care provider.
KM: Medical gaslighting is real. A growing population of folks feel they are not being listened to.
AB: What have you found to be the single most successful or persuasive message that results in someone getting screened for cancer for the first time?
TF: The message that colorectal cancer can be prevented through screening and that polyps can be removed during a colonoscopy. Cervical cancer is similar, where we can say getting this screening is preventive. When we're able to tell people that this is preventive, that brings us a little further.
AB: How do we increase physical presence and health care education within communities in the digital age? During the pandemic, we leveraged pharmacies. But is that enough? And should we push for local advocacy clinics or something along those lines?
KM: Health care does not have to be contained within the box of a health care delivery setting. We saw clearly with vaccinations that it could happen at a pharmacy, a grocery store, or even a parking lot. It opened the aperture of where education and even vaccinations can take place. Right now, we're working with food banks to redefine their role in health care delivery and in driving more equitable health. It’s no secret that food insecurity and poor health outcomes go hand in hand, so how do we close that gap? There's an open question as to whether we can deploy community health workers in a food bank to direct, navigate, and educate the folks there. This is an audience that isn't going to go to the clinic, but they are coming to the food bank. I would argue the same thing could be said about Goodwill and Salvation Army. There will be a dollar store for people living in food deserts. How do we leverage the fact that we've got dollar stores all over? In fact, they have the largest footprint of any organization in the United States. How do we leverage that?
Some technology companies have begun stepping back from their diversity, equity, and inclusion initiatives. Regarding diversifying the workforce, would the health care industry step up and advocate or push those same companies to continue growing diverse workforces in terms of their recruitment and the development of their people?
KM: Three years post George Floyd's murder, we have reached the point where funding and energy have gone away. I have been sharing with my clients and community activists that focusing on health equity is good for business. Until you can establish the return on investment, we will continue to see cycles of organizations making DEI investments and then shifting focus. There needs to be a solid business case for engaging in this.
TF: I love that these conversations are happening with folks from such a broad group of people who work in all areas of industry and health. There’s a narrow window for pushing things around equity, and I would encourage folks to stay focused. This is hard work. Don't give up.
KM: This is a marathon, not a foot race. All the disparities and inequities we see did not happen overnight; therefore, we cannot expect to snap our fingers and somehow be reversed. We should embrace the successes that we have. Please take the opportunity to disseminate your findings in whatever way, shape, or form you can because the aggregation of all our learnings will keep this conversation moving.